This has not been a good year for steroids. For the last few weeks, the big news in sports has been the controversial use of deer antler spray, a synthesized performance enhancing drug that athletes spray under the tongue. This comes just weeks after Lance Armstrong admitted to blood doping during his seven-year reign as Tour de France champion.
What happened to good old-fashioned steroids? Anabolic steroids have taken a back seat to new idiotic ways to juice up.
Although different from their anabolic steroid counterparts, corticosteroids are also receiving bad press. Clinicians commonly use corticosteroids to reduce inflammation to tissues. Shoulders, hips, knees, ankles and feet can receive steroid injections for problems including tendonitis, arthritis, fasciitis, synovitis and many other painful conditions.
The new competition for steroids in the treatment of one of podiatry's most common complaints, plantar fasciitis, is Botox (Allergan). Botulinum toxin or Botox (BTX-A) has been a useful treatment in other avenues of medicine, most notably in aesthetic practices to reduce wrinkles. Botox is a protein and neurotoxin that blocks the release of acetylcholine in overactive muscles. It paralyzes the facial muscles whose activity causes wrinkles over time.
A recent study from Foot and Ankle International compared steroid injections with Botox injections to treat plantar fasciitis.1 Researchers randomly divided and treated 36 patients with either Botox injections to the gastroc-soleus muscle complex or traditional steroid injections to the painful insertion area of the plantar fascia. Both treatment groups supplemented their therapy with plantar fascia stretching exercises. The results of the study show that, "When compared to patients who received steroids, the patients who received BTX-A exhibited more rapid and sustained improvement over the duration of the study."1
The study concluded that BTX-A injections coupled with stretching are superior to steroid injections and stretching. Although the support for BTX-A injections is limited, they are gaining popularity in podiatry.
Clinicians have utilized BTX-A to help achieve relief for spastic flat or cavus foot types. Burbaud and colleagues found BTX-A useful for spastic feet in hemiparetic patients.2 Researchers treated 23 hemiparetic patients with spastic plantarflexion-inversion deformities in a double-blinded, placebo controlled study. Patients received one Botox and one placebo injection in random order on days zero and 90. Results were conclusive that BTX was a useful treatment for spastic flatfoot in the first year after a stroke.
Abandoning steroids for the latest fad will not help you win the Super Bowl or the Tour de France. But with the success of the modality in paralyzing facial muscles, Botox's use in conjunction with stretching could be a valid alternative to traditional intralesional steroid injections for plantar fasciitis.
1. Elizondo-Rodriguez J. A comparison of botulinum toxin A and intralesional steroids for the treatment of plantar fasciitis: a randomized, double-blinded study. Foot Ankle Int. 2013; 34(1):8-14.
2. Burbaud P. A randomized, double blind, placebo controlled trial of botulinum toxin in the treatment of spastic foot in hemiparetic patients. J Neurol Neurosurg Psychiatry. 1996; 61(3):265-9.
Should you have any questions on this topic, please contact Dr. Bowman at www.houstonfootspecialists.com  . As always, comments on this subject are welcome.